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John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This is the start of a new series of posts that I plan to do over the next week or two. I’ll probably try and space them out so that they don’t overwhelm anyone. However, it’s going to be a series of common EMR implementation issues that I hear over and over again.

This series was prompted by a post on HIStalk by Inga where she talked about her visit to the doctor and his complaints about his EHR implementation. As I read through the list of complaints, I realized that they were all complaints that I’d heard before. If I’ve heard them all before, then they must be pretty common and worth talking about more.

Ideally the discussions in this EMR implementation series will help practices and doctors that are implementing an EMR to avoid these issues. I also know that I don’t necessarily know all the answers to avoiding these problems. So, I welcome others feedback on ways to avoid these problems in the comments as well.

Today’s Common EMR Implementation Problem: Many Unexpected Expenses

I can’t tell you how many times I’ve heard a doctor or medical practice talk about all the hidden expenses that they incurred during their EHR implementation that they didn’t plan for. Here are 3 tips to help you avoid this situation.

Unexpected EHR Expense Tip #1 – Plan for hidden expenses. Add $5000+ to your budget for hidden expenses. Hopefully you won’t have to use it, but if (and likely when) you need to use it you’ll already have it in your budget.

Unexpected EHR Expense Tip #2 – Get your EHR vendor to outline everything and anything they could charge you for. Once they’ve done that, consider putting the list of expenses in your EMR contract so that new expenses from your EHR vendor won’t appear. Here’s just a few EHR expenses that you might incur (and may not expect):
-Up front fee (almost everyone just focuses on this)
-Maintenance Fees (monthly, annually, etc)
-Upgrade Fees (to update your software…these are sometimes called Hot Fixes)
-Interface Fees (both sides of the interface..ie. lab and EMR company)
-Device Integration
-Training Fees
-Support Fees
-Licensing Fees (to license their various databases and/or clinical content)
-Install Fees
-Other non-standard modules – You mean you didn’t realize that the patient portal was an extra $150/month?
-EHR or PMS data migration Fees
-Template Creation Fees
I’m sure there are others that I’ve missed. I look forward to seeing the comments on this. I’ll update the post with other suggestions as they come in. As you can see, EHR vendors can charge you in lots of interesting ways.

Unexpected EHR Expense Tip #3
While EHR vendors can often throw unexpected fees at you, it’s probably even more likely that the other outside purchases you have to make during your EMR implementation will be a surprise. Here’s a list for you to consider the other EMR implementation related fees that might come unexpectedly:
-Server cost (almost everyone focuses on this)
-Software cost (including the operating system or third party software your EHR vendor might require)
-New Desktop/Laptop Costs
-Upgrading Desktop/Laptop Costs – You might find that your existing computers aren’t powerful enough to run the EHR you chose. This is particularly true if you’re using something like voice recognition with your EHR.
-Fax Server
-Fax Server Software
-Scanners – Yes, that is plural and people often start with one scanner and then have the unexpected cost of another scanner because they could really use 2+ scanners. Other times people use a cheap all in one scanner which quickly dies after they start scanning in bulk and they realize they need to buy a $1000+ scanner that can handle the required scanning
-Printers – You’ll likely need a few of these to print our prescriptions, patient education, etc etc etc. Plus, you’ll often need a better printer than the one you have.
-Dragon Medical Voice Recognition – The software, the mic (spend extra for a great one), etc. Some don’t realize all of this costs and doesn’t usually come with the EHR software.
-New Network Ports – You could go wireless, but many like the reliability of a wired connection. This costs to run the lines and cut out new internet connections
-Bigger Internet Connection – This is particularly true with a SaaS EHR setup. You think your current internet connection is enough and then you realize you need to pay for a bigger pipe (internet connection) or possibly even a second “backup” internet connection
-Backup Software
-Backup Hardware
-Off site Backup Service
-Cables – Lots and lots of cables required. Sometimes you even have the cable, but then realize you want a longer one. Unexpected expense!
-Power strips and other peripherals – $10 here and $10 there. This stuff starts to add up. Plus, get ready for things like your mouse to start breaking now that you’re using it a lot more.
-UPS (uninterruptible power supply)Chip Hart added the following suggestions (Thanks!):
-Practices should purchase 25-50% more laptops/tablets (and/or batteries) than they expect.
-All those laptops and tablets will need a SECURE storage and recharge barn.
-You may be paying a carpenter and electrician.
-Integration fees? Data conversion fees?
-Will you need hands-free headsets for your staff, now?
-Maybe it’s time to get bigger monitors.

Hopefully the above lists will help you plan for all of the various fees that are associated with an EHR implementation. Many of these EMR costs are necessary, but end up being really annoying when you didn’t know they were coming. Check through this list to see if you’ve planned for all the EHR costs.

In a future post, I’ll see if I can’t take the above list and give you some ideas on how you can save on some of the costs above.

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